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Screening vs Diagnostic Colonoscopy

  1. #1
    Default Screening vs Diagnostic Colonoscopy
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    Hi All,

    When screeening colonoscopy is converted into thereaupetic colonoscopy.i.e. a medicare pt comes for screening and done with a polypectomy then how i can bill? Is there any modifier.

    In this case,I used to bill only for polypectomy but one of my friend confused me that there may some modifier in these cases. If so means please let me know.

    Please explain me with any documentation if any of you have...

    Waiting for Replies....................

    Thanks,
    Soundar


  2. #2
    Smile
    You will have to use the polypectomy code; 45380 45383 45384 45385 and use modifer PT since the patient was there for a screening. Still use the screening dx as the primary dx when coding since you're billing Medicare. Hope this helps...

  3. #3
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    Columbia, MO
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    Quote Originally Posted by SoundarR View Post
    Hi All,

    When screeening colonoscopy is converted into thereaupetic colonoscopy.i.e. a medicare pt comes for screening and done with a polypectomy then how i can bill? Is there any modifier.

    In this case,I used to bill only for polypectomy but one of my friend confused me that there may some modifier in these cases. If so means please let me know.

    Please explain me with any documentation if any of you have...

    Waiting for Replies....................

    Thanks,
    Soundar

    It has always been that you code the screening dx first as that is the reason the patient came for the procedure, the polyps are an incidental finding and therfore a secondary dx. The documentation for this can be found in the coding guidelines, when the purpose of the procedure is screening, screening remains you first listed dx code regardless of the findings and subsequent procedure performed.
    The PT or 33 modifies were created for use Jan 1 2011 and forward and are to be appended to the diagnostic procedure to show that it started as a screening but became diagnostic. The modifier will depend on the payer and the documentation can be found either on the CMS website for the PT or the AMA website for the 33.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default
    Quote Originally Posted by mitchellde View Post
    It has always been that you code the screening dx first as that is the reason the patient came for the procedure, the polyps are an incidental finding and therfore a secondary dx. The documentation for this can be found in the coding guidelines, when the purpose of the procedure is screening, screening remains you first listed dx code regardless of the findings and subsequent procedure performed.
    The PT or 33 modifies were created for use Jan 1 2011 and forward and are to be appended to the diagnostic procedure to show that it started as a screening but became diagnostic. The modifier will depend on the payer and the documentation can be found either on the CMS website for the PT or the AMA website for the 33.
    Thanks a lot..

    One more doubt, can we use PT modifier for all payers (Medicare,Commercial..) & if we are processing with PT modifier means do we need any additional documentation that we have to submit with that claim.Please advice me...

  5. #5
    Default
    Quote Originally Posted by mitchellde View Post
    It has always been that you code the screening dx first as that is the reason the patient came for the procedure, the polyps are an incidental finding and therfore a secondary dx. The documentation for this can be found in the coding guidelines, when the purpose of the procedure is screening, screening remains you first listed dx code regardless of the findings and subsequent procedure performed.
    The PT or 33 modifies were created for use Jan 1 2011 and forward and are to be appended to the diagnostic procedure to show that it started as a screening but became diagnostic. The modifier will depend on the payer and the documentation can be found either on the CMS website for the PT or the AMA website for the 33.
    Thanks a lot Mitchell..

    One more doubt, can we use PT modifier for all payers (Medicare,Commercial..) & if we are processing with PT modifier means do we need any additional documentation that we have to submit with that claim.Please advice me...

    Also if you want me to code CPT Polypectomy alone means,if i code screening dx first means did Payer accept it as per LMRP? Please advice..

    Thanks,
    Soundar

  6. #6
    Location
    Columbia, MO
    Posts
    12,560
    Default
    I am not sure if you can use the PT with all payers, It is definitely for Medicare, however other payers have not weighed in yet except on a case by case basis. However it it does turn diagnostic you will need either the PT or the 33 and you will need to check with each payer on which modifier they prefer.
    I would not submit any documentation with the intial submission just because you use the modifier , it is not required, however it can be requested at any time.
    On your last question I am not sure what you are asking. But let me state if the patient came for a screening test and are asymtomatic, then we are required to list the V code for screening as the first listed dx code, regardless of the LMRP, or any findings during the course of the screening. We cannot change the reason for the test just to match a payment determination.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Smile Thanks
    Thanks a lot Mitchell.

    It really helps a lot...

    Warm Regards,
    Soundar.

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